High Blood Pressure Treatments
There are several treatments available to manage hypertension (high blood pressure), including:
- Lifestyle changes: Lifestyle modifications such as adopting a healthy diet, regular exercise, maintaining a healthy weight, reducing sodium intake, limiting alcohol intake, and quitting smoking can help lower blood pressure.
Medications: If lifestyle changes are not enough to control hypertension, medications may be prescribed. Some commonly prescribed medications include diuretics, ACE inhibitors, angiotensin II receptor blockers (ARBs), beta-blockers, calcium channel blockers, and aldosterone antagonists.
Combination therapy: In some cases, a combination of two or more medications may be prescribed to control hypertension effectively.
Surgery: In rare cases, surgery may be an option to treat hypertension. Renal artery stenosis, a condition where the arteries that supply blood to the kidneys narrow, can be treated with surgery to restore blood flow.
- Lifestyle interventions: Lifestyle interventions like stress reduction techniques and relaxation therapies can also help to manage hypertension.
We'll go into detail on some of these below.
Lifestyle Changes for High Blood Pressure
Maintaining a healthy weight:
Being overweight or obese can increase blood pressure.Losing weight can have a significant impact on lowering blood pressure, especially in people who are overweight or obese. The exact amount by which blood pressure can be lowered with weight loss can vary depending on the individual and the severity of their hypertension.
However, studies have shown that losing as little as 5% to 10% of body weight can significantly reduce blood pressure. On average, for every 1 kg (2.2 pounds) of weight loss, blood pressure can decrease by approximately 1 mmHg. This means that if you lose 10 kg (22 pounds), your blood pressure could potentially decrease by around 10 mmHg.
Regular physical activity:
Physical activity can help lower blood pressure in several ways:
- Strengthening the heart: Regular physical activity can strengthen the heart muscle and improve its ability to pump blood, which can help reduce the pressure on blood vessels.
- Reducing the workload on the heart: Physical activity can help reduce the workload on the heart by decreasing the resistance in the blood vessels, allowing blood to flow more easily.
- Improving blood vessel function: Physical activity can help improve the flexibility and function of blood vessels, which can also reduce blood pressure.
- Reducing stress: Physical activity can help reduce stress levels, which can have a positive effect on blood pressure.
- Promoting weight loss: Physical activity can help with weight loss, which can reduce blood pressure in overweight or obese individuals.
- Reducing inflammation: Physical activity has been shown to reduce inflammation in the body, which can have a positive effect on blood pressure.
It is important to note that physical activity should be done regularly and consistently to see the benefits on blood pressure. The American Heart Association recommends at least 150 minutes of moderate-intensity aerobic exercise per week, or 75 minutes of vigorous-intensity aerobic exercise per week, or a combination of both, along with muscle-strengthening exercises at least two days per week.
The exact amount by which physical activity can lower blood pressure can vary depending on factors such as the individual's starting blood pressure level, the type and intensity of physical activity, and the duration and frequency of physical activity. However, studies have shown that regular physical activity can lead to a reduction in systolic blood pressure (the top number) of approximately 5 to 10 mmHg and a reduction in diastolic blood pressure (the bottom number) of approximately 3 to 5 mmHg on average.
Eating a healthy diet
- Reducing sodium intake: A diet high in sodium can increase blood pressure. Reducing sodium intake by avoiding processed foods, not adding salt to meals, and choosing low-sodium options can help lower blood pressure.The American Heart Association (AHA) recommends that people with hypertension (high blood pressure) limit their daily sodium intake to no more than 1,500 milligrams (mg) per day. This is because consuming too much sodium can cause the body to retain excess fluid, which can increase blood pressure.
The AHA also recommends that the general population limit their daily sodium intake to no more than 2,300 mg per day. However, people with hypertension, older adults, and African Americans may be more sensitive to the blood pressure-raising effects of sodium, and therefore may benefit from a lower sodium intake. - Increasing potassium intake: Potassium helps to counteract the effects of sodium on blood pressure. A diet rich in potassium, which can be found in fruits and vegetables, can help lower blood pressure. For hypertension management, the American Heart Association (AHA) recommends a daily potassium intake of 3,500 to 5,000 milligrams (mg) for most adults. This is because potassium has been shown to help counteract the effects of sodium on blood pressure. Most American diets do not contain nearly enough potassium to reach the Recommended Daily Allowance (RDA).
However, it is important to note that people with certain medical conditions, such as kidney disease, may need to limit their potassium intake. In addition, people taking certain medications, such as potassium-sparing diuretics, may need to monitor their potassium intake more closely. - Eating a diet rich in fruits and vegetables: Fruits and vegetables contain antioxidants, fiber, and other nutrients that can help lower blood pressure and promote heart health.
- Choosing whole grains: Whole grains, such as brown rice, whole wheat bread, and quinoa, are a good source of fiber, which can help lower blood pressure. One way fiber can help lower blood pressure is by promoting healthy digestion and reducing the risk of constipation. Constipation can cause temporary spikes in blood pressure, so maintaining regular bowel movements can help keep blood pressure levels stable.
Fiber also helps reduce inflammation in the body, which is a risk factor for many chronic diseases, including high blood pressure. Inflammation can damage blood vessels and make it harder for blood to flow through them, which can contribute to high blood pressure. By reducing inflammation, fiber can help improve blood flow and lower blood pressure.
In addition, fiber can help improve cholesterol levels, which is another risk factor for heart disease and high blood pressure. Soluble fiber, in particular, has been shown to reduce levels of "bad" LDL cholesterol in the blood, which can help lower blood pressure and reduce the risk of heart disease. - Eating lean protein: Eating lean protein, such as chicken, fish, and legumes, can help lower blood pressure and reduce the risk of heart disease.
- Limiting saturated and trans fats: Saturated and trans fats can raise blood cholesterol levels and increase the risk of heart disease. Choosing lean meats, low-fat dairy products, and plant-based fats, such as olive oil and avocado, can help lower blood pressure.
- Limiting alcohol intake: Drinking too much alcohol can increase blood pressure. It is recommended that men should have no more than two drinks per day, and women should have no more than one drink per day.
Quitting smoking:
Smoking can cause damage to blood vessels and increase the risk of hypertension. Quitting smoking can help lower blood pressure and reduce the risk of cardiovascular disease.
Managing stress:
Chronic stress can contribute to hypertension. Finding ways to manage stress, such as deep breathing, meditation, or yoga, can help lower blood pressure.
- Meditation can help lower blood pressure and reduce the risk of hypertension through its ability to reduce stress and promote relaxation. Stress is a known risk factor for hypertension, and chronic stress can lead to an increase in blood pressure over time. By reducing stress levels, meditation can help lower blood pressure and reduce the risk of hypertension.
Several studies have shown that regular meditation practice can lead to significant reductions in blood pressure. For example, a meta-analysis of 19 studies found that transcendental meditation (a type of meditation that involves repeating a mantra) led to an average reduction in systolic blood pressure (the top number) of 4.26 mmHg and an average reduction in diastolic blood pressure (the bottom number) of 2.33 mmHg. Another study found that mindfulness-based stress reduction (a type of meditation that focuses on non-judgmental awareness of the present moment) led to an average reduction in systolic blood pressure of 4.8 mmHg and an average reduction in diastolic blood pressure of 2.3 mmHg.
High Blood Pressure Medications
Thiazide or Thiazide-like diuretics:
Thiazide diuretics, such as hydrochlorothiazide, and thiazide-like diuretics, such as chlorthalidone, are a class of medications that are commonly used to treat hypertension as a first line treatment. These medications work by increasing the excretion of sodium and water in the kidneys, which leads to a decrease in blood volume and a reduction in blood pressure.Thiazide diuretics work by blocking the reabsorption of sodium and chloride ions in the kidneys, which causes them to be excreted in the urine. This leads to a decrease in the amount of water in the blood vessels, which in turn reduces blood volume and lowers blood pressure. Thiazide diuretics also cause the blood vessels to relax and dilate, which can further lower blood pressure.
Thiazide-like diuretics, such as chlorthalidone, work in a similar way to thiazide diuretics but are more potent and have a longer duration of action. They also inhibit the reabsorption of sodium and chloride ions in the kidneys, which causes an increase in the excretion of water and electrolytes, leading to a reduction in blood volume and blood pressure.
Thiazide and thiazide-like diuretics are usually taken once daily and have been shown to be effective in reducing blood pressure in both systolic and diastolic readings. These medications are generally well tolerated and have few side effects when used at low to moderate doses. However, they can cause electrolyte imbalances, particularly low levels of potassium, which can be monitored and managed with dietary modifications or potassium supplements if necessary.
ACE inhibitors (Angiotensin-Converting Enzyme inhibitors):
ACE inhibitors work by blocking the action of an enzyme called angiotensin-converting enzyme (ACE). ACE is responsible for converting angiotensin I, a hormone produced by the liver, into angiotensin II, a potent vasoconstrictor. By blocking ACE, ACE inhibitors reduce the production of angiotensin II, which leads to vasodilation and a reduction in blood pressure.
In addition to reducing blood pressure, ACE inhibitors can also help to protect the heart and kidneys in people with hypertension, diabetes, or heart failure. They are usually taken once or twice daily in pill form and are often used in combination with other blood pressure-lowering medications. Lisinopril is a commonly prescribed ACE inhibitor.
ARBs (Angiotensin Receptor Blockers):
ARBs (Angiotensin Receptor Blockers) are another type of medication used to treat hypertension or high blood pressure. They work by blocking the action of a hormone called angiotensin II, which is responsible for constricting blood vessels and increasing blood pressure.
Angiotensin II is produced in the body by the action of angiotensin-converting enzyme (ACE). ACE inhibitors (as mentioned in the previous answer) work by blocking the activity of ACE, thereby reducing the production of angiotensin II. ARBs, on the other hand, work by blocking the receptor sites where angiotensin II attaches and exerts its effects.
By blocking the action of angiotensin II, ARBs cause the blood vessels to relax and widen, which reduces the resistance to blood flow and lowers blood pressure. ARBs also reduce the production of aldosterone, another hormone that can cause the body to retain salt and water, leading to increased blood volume and elevated blood pressure.
Like ACE inhibitors, ARBs are usually taken once or twice daily in pill form and can be used in combination with other blood pressure-lowering medications. Losartan is a commonly prescribed ARB.
Calcium channel blockers:
Calcium channel blockers (CCBs) are another type of medication used to treat hypertension or high blood pressure. They work by blocking the entry of calcium into the muscle cells of the blood vessels and the heart, which causes the blood vessels to relax and widen, and reduces the workload of the heart.
Calcium plays an important role in regulating the contraction of smooth muscle cells in the walls of blood vessels. When calcium enters these cells, it triggers a series of chemical reactions that cause the cells to contract and narrow the blood vessels. This can increase resistance to blood flow and elevate blood pressure.
CCBs work by blocking the entry of calcium into these cells, which reduces the degree of muscle contraction and causes the blood vessels to relax and widen. This reduces the resistance to blood flow and lowers blood pressure.
CCBs are available in two main types: dihydropyridine and non-dihydropyridine. Dihydropyridine CCBs are more selective in blocking calcium channels in the blood vessels and are more effective at lowering blood pressure. Non-dihydropyridine CCBs have more selectivity for calcium channels in the heart and are more effective at reducing heart rate and controlling certain types of arrhythmias.
Beta-blockers:
Beta blockers are a type of medication that can be used to treat hypertension or high blood pressure. They work by blocking the effects of a hormone called epinephrine (also known as adrenaline) on the beta receptors in the heart and blood vessels.
Epinephrine is a hormone that is released by the adrenal gland in response to stress, exercise, or other triggers. It can increase heart rate, contractility, and vascular resistance, which can increase blood pressure. By blocking the effects of epinephrine on the beta receptors, beta blockers can reduce heart rate, cardiac output, and vascular resistance, which leads to a reduction in blood pressure.
Beta blockers can be selective or non-selective. Selective beta blockers block the beta-1 receptors in the heart, which reduces heart rate and contractility, without significantly affecting the beta-2 receptors in the blood vessels, which can cause constriction. Non-selective beta blockers block both the beta-1 and beta-2 receptors, which can cause some constriction in the blood vessels and reduce blood flow to certain areas of the body. Propranolol is a commonly prescribed Beta Blocker.
Aldosterone Agonists
Aldosterone agonists are a type of medication that can be used to treat hypertension or high blood pressure. They work by blocking the effects of a hormone called aldosterone, which is produced by the adrenal glands and regulates the balance of sodium and potassium in the body.
Aldosterone promotes the reabsorption of sodium and the excretion of potassium in the kidneys, which can increase blood volume and raise blood pressure. By blocking the effects of aldosterone, aldosterone agonists can reduce sodium reabsorption and increase potassium excretion in the kidneys, which can lead to a reduction in blood volume and blood pressure.
There are two main types of aldosterone agonists: mineralocorticoid receptor antagonists (MRAs) and selective aldosterone receptor antagonists (SARAs).
MRAs, such as spironolactone and eplerenone, bind to the mineralocorticoid receptors in the kidneys and other tissues, blocking the effects of aldosterone. They can be effective in treating hypertension, as well as heart failure and other conditions related to fluid retention. MRAs can cause some side effects, such as potassium retention, breast tenderness, and menstrual irregularities.
SARAs, such as finerenone, are more selective in blocking the aldosterone receptor, and may be associated with fewer side effects than MRAs. Finerenone has been approved for the treatment of hypertension in patients with chronic kidney disease and type 2 diabetes.